Identifying Unmet Palliative Care Needs Among Hospitalized Patients with COPD Arrix Ryce Katherine Courtright, MD, MS; Beth Cooney, MPH; Scott Halpern, MD, PhD SUMR Program Symposium 18 August 2017
Chronic Obstructive Pulmonary Disease (COPD) 15 million 5 days Americans 20% Average Length of Stay #3 $6 billion Hospitalized Patients Cause of Death over 40 years old Annual Cost 2 Centers for Disease Control and Prevention (CDC): Chronic Obstructive Pulmonary Disease (COPD), 2011; Wier et al. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs, 2011; MMWR Weekly: Deaths from Chronic Obstructive Pulmonary Disease - United States, 2000-2005, 2008.
Palliative Care specialized medical care for seriously ill individuals and their families that provides relief from symptoms and stress at any age and at any stage in a serious illness 3 National Palliative Care Research Center.
Rapid Growth of Hospital-based Palliative Care Programs 347% 6% 78% increase in annual hospital admissions seen by palliative care team 1998 2014 Among U.S. hospitals 50 beds Center to Advance Palliative Care; Dumanovsky et al. J Palliat Med,2016. 4
Inadequate Palliative Care Delivery for Patients with Advanced COPD Uncontrolled dyspnea, anxiety, and depression Reduced quality of life Substantial suffering during a prolonged functional decline Lower likelihood of palliative care referrals Lunney JR et al. JAMA 2003. 5 Tranmer et al. J Pain Symptom Manage, 2003; Cleland et al. Fam Pract, 2007; Elkington et al. Respir Med, 2004; Kunik et al. Chest, 2005; McSweeney et al. Chest, 1980; Light et al. Chest, 1985; Beernaert K et al. Respiratory medicine, 2013.
Characterizing the Barriers to Palliative Care Delivery Objective: To determine clinicians perceptions of excess consult demand and current consult-limiting strategies employed by programs Method: Qualtrics anonymous web-based survey (~5 minutes) Sample population: American Academy of Hospice and Palliative Medicine Domains of Interest Clinician, program, & consult characteristics Perception of consult volume Consult-limiting strategies 6
Palliative Care Consults Per Day 7
Management of Palliative Care Consult Volume 8
Characterizing the Palliative Care Needs of Hospitalized COPD Patients Objective: To understand the palliative care needs of hospitalized patients with COPD, their perceptions of palliative care, and their preferences for different approaches to address their needs Method: Semi-structured interviews (~25-30 minutes) Sample population: Hospitalized patients with COPD within the University of Pennsylvania Health System 9
Identifying the Needs of COPD Patients 1 2 3 Develop a semi-structured interview guide. Interview hospitalized patients with COPD and their caregivers. Analyze interview transcripts. 4 Identify common themes. 10
Domains of Interest UNMET PALLIATIVE CARE NEEDS KNOWLEDGE AND PERCEPTIONS OF PALLIATIVE CARE ACCEPTANCE OF SPECIALTY PALLIATIVE CARE 11
Domains of Interest UNMET PALLIATIVE CARE NEEDS How much do you suffer from physical symptoms such as pain, shortness of breath, fatigue, or nausea? Do you ever feel anxious or depressed about your illness? Do you feel the medical care you are receiving fits with your goals? Have you shared those goals with your doctors? 12
Domains of Interest KNOWLEDGE AND PERCEPTIONS OF PALLIATIVE CARE What is your familiarity with palliative care? How would you define it? I m hearing you use the word hospice, is this interchangeable with palliative care for you or do you see a distinction? 13
Provide participants with a consensus definition of specialty palliative care. specialized medical care for seriously ill individuals and their families that provides relief from symptoms and stress at any age and at any stage in a serious illness 14
Domains of Interest ACCEPTANCE OF SPECIALTY PALLIATIVE CARE Would this kind of care be helpful for COPD patients who are experiencing some of the symptoms and feelings we ve discussed today? Would you want this kind of care for your family and friends? For yourself? Can you imagine a time when you would not want this kind of care? 15
Identifying the Needs of COPD Patients 1 2 3 Develop a semi-structured interview guide. Interview hospitalized patients with COPD and their caregivers. Analyze interview transcripts. 4 Identify common themes. 16
Future Directions Perform a cross-sectional survey to determine the frequency and intensity of palliative care needs among hospitalized patients with COPD. Develop a natural language processing (NLP) classifier of unmet palliative care needs among hospitalized patients with COPD using electronic health records (EHR). Describe the epidemiology of patients with COPD and unmet palliative care needs during a hospitalization and the palliative care consultation practices utlized among these patients. 17
Lessons Learned Utility of mixed-methods research approaches Delivery of palliative care Data analysis and visualization using Stata Complexity of medical decision-making Synthesis and translation of academic literature 18
Acknowledgments Additional staff and research affiliates of the Palliative and Advanced Illness Research (PAIR) Center 19
Questions?